Dysphagia assessment in the elderly

Dysphagia becomes an increasingly common problem as people age; its prevalence and the increased risk of related complications (aspiration pneumonia, dehydration, malnutrition) has brought the attention of dysphagia specialists to the elderly. Dysphagia assessment in the elderly relies primarily on the same modalities as in other age groups: history, bedside examination, fiberoptic endoscopic examination of swallowing, and videofluoroscopy. However, the elderly often show differences in anatomy and physiology, as well as in the diseases presented and the environment in which they live; specialists involved in dysphagia assessment should take these specific aspects into consideration. Modification of swallowing simply related to aging is called primary presbyphagia, while swallowing impairment due to diseases in the elderly is called secondary presbyphagia. The main characteristics of deglutition and deglutition disorders in the elderly are thus reviewed here, with special emphasis on the assessment and decision-making implications specific for this patient category